ACUTE ABDOMEN AND INTESTINAL OBSTRUCTION.pptx

Abdominal disorders

1. ACUTE ABDOMEN AND INTESTINAL OBSTRUCTION Group Three discussion

2. Definition It is the abrupt onset of abdominal pain that may signal perforation ,obstruction or rupture. Its causes are as follows; abdominal penetrating trauma Appendicitis bowel obstruction with perforation or necrosis Pancreatitis gastroenteritis

3. CLINICAL MANIFESTATION Pain- dull in hollow organs ,sharp in peritoneum or in waves Abdominal tenderness Fever A bdominal distention Nausea and vomiting Signs of shock Signs of peritonitis F latulence

4. Diagnostics History taking Physical examination Rectal and pelvic CBC X Ray ECG

5. ETIOLOGY Inflammatory Conditions Appendicitis (most common surgical cause) Diverticulitis Cholecystitis (gallbladder inflammation) Pancreatitis Gastroenteritis 2. Obstructive Causes Small bowel obstruction Large bowel obstruction Biliary colic (gallstones) Ureteric colic (kidney stones) 3. Perforation Perforated peptic ulcer Perforated diverticulum Perforated appendix 4. Vascular Causes Mesenteric ischemia Abdominal aortic aneurysm rupture Ovarian torsion (in females) 5. Gynecological Causes (Females) Ectopic pregnancy Ovarian cyst rupture Pelvic inflammatory disease 6. Traumatic Blunt abdominal trauma Penetrating injuries

6. PATHOPHYSIOLOGY Results from visceral or parietal peritoneal irritation due inflammation, ischemia, perforation or obstruction.

7. INTESTINAL OBSTRUCTION

8. DEFINITION Is a partial or complete blockage of the small or large intestine that prevents the normal passage of food,fluids & gases

9. CLINICAL MANIFESTATIONS Abdominal pain Vomiting Absolute constipation(no flatus or stool) Blotting Abdominal distention Dehydration fever

10. TYPES OF INTESTINAL OBSTRUCTION ARE 2 TYPES: Mechanical Non mechanical

11. MECHANICAL Adhesions-fibrous tissue that develop usually after abdominal or pelvic surgery. Volvulus-twisted bowel Intussusception-telescoping of the bowel when a segment of bowel pushes into another segment causing it to collapse. Tumors-small & large bowel cancer Hernias- which can cause strangulation of the bowel.

12. TYPES OF HERNIAS A hernia occurs when an organ or fatty tissue squeezes through a weak spot in a surrounding muscle or connective tissue (fascia). This creates a bulge or protrusion that can be seen or felt, especially when straining, lifting, or coughing . Types of Hernia There are several types of hernias, depending on their location : 1. Inguinal Hernia Location : This is the most common type of hernia. It occurs in the groin area when tissue pushes through a weak spot in the abdominal muscles near the inguinal canal (a passageway for blood vessels and the spermatic cord in men, or the round ligament in women). Symptoms: A bulge in the groin area, pain or discomfort (especially when straining), and a heavy or dragging sensation . 2 . Incisional Hernia : Location: Develops at the site of a previous surgical incision. Symptoms: A bulge near the incision site, discomfort or pain, and may worsen with activity   3. Umbilical Hernia : Location: Occurs near the navel (belly button) when tissue pushes through a weak spot in the abdominal muscles. Symptoms: A bulge near the belly button, discomfort, and is common in infants and pregnant women 4. Hiatal Hernia : Location: Occurs when the upper part of the stomach protrudes through the diaphragm (the muscle separating the chest and abdomen) into the chest cavity. Symptoms: Heartburn, acid reflux, difficulty swallowing, chest pain .

13. S 5. Femoral Hernia Location: Similar to inguinal hernias but occur lower in the groin, near the femoral artery. Symptoms: A bulge in the upper thigh near the groin, pain or discomfort, and are more common in women.  Causes of Hernias : Weakened Muscles : Muscle weakness can be congenital (present at birth) or develop over time due to aging, injury, surgery, or chronic coughing. Straining: Straining during bowel movements, urination, or heavy lifting can increase pressure in the abdomen and contribute to hernia development. Obesity: Being overweight or obese increases pressure on abdominal muscles, increasing the risk of hernias. Pregnancy: Pregnancy can weaken abdominal muscles and increase pressure in the abdomen. Chronic Coughing : Persistent coughing can strain abdominal muscles. Heavy Lifting : Lifting heavy objects improperly can strain abdominal muscles. symptoms :   Bulge: A visible or palpable bulge in the affected area. Pain or Discomfort : Pain, aching, or a heavy sensation in the area of the hernia, especially when straining, lifting, or coughing. Increased Pain with Activity:Discomfort that worsens with physical activity or prolonged standing. Relief When Resting : Symptoms may improve when lying down. In some cases, there may be no symptoms at all .  

14. **Complications :** * **Incarceration:** The herniated tissue becomes trapped and cannot be easily pushed back in. This can cause pain, nausea, vomiting, and bowel obstruction. * **Strangulation:** The blood supply to the incarcerated tissue is cut off, leading to tissue death (necrosis). This is a medical emergency. * **Obstruction:** A hiatal hernia can cause obstruction of the esophagus , leading to difficulty swallowing.   **Diagnosis:** * **Physical Examination:** The doctor will examine the affected area for a bulge and assess your symptoms. * **Imaging Tests:** * *Ultrasound* * *CT Scan* * *MRI* **Treatment :** * **Watchful Waiting:** Small hernias with minimal symptoms may be monitored without treatment. * **Lifestyle Changes:** Weight loss, avoiding heavy lifting, and quitting smoking can help manage symptoms. * **Truss:** A supportive device worn over the area to keep the hernia in place. * **Surgery:** Hernia repair surgery is often recommended, especially if the hernia is causing pain or complications. * *Open Surgery

15. Types of mechanical obstruction cont’d Swallowed objects Inflammatory bowel disease-like crohn’s & ulcerative colitis can cause strictures or narrowing in the bowel causing obstruction Impacted stool Infection diverticulitis

16. NON-MECHANICAL OBSTRUCTION A non-mechanical obstruction is also referred to as ‘ileus’ or ‘paralytic ileus’, this is when the natural movement of the bowel called peristalsis fails to happen. Ileus is usually temporary. Some medical conditions can cause this to have a long term effect and this is called ‘Intestinal pseudo-obstruction. This can be caused by : Abdominal or pelvic surgery Infections such as gastroenteritis or appendicitis Opioid pain medications such as morphine or codeine Parkinson’s Disease Diabetes Mellitus Hirschsprung’s Disease Hypothyroidis

17. PATHOPHYSIOLOGY The bowel becomes dilated proximal to the site of obstruction and fluid is sequestered due to impaired reabsorption. Major fluid shift can occur, as upto 10litres of fluids can be secreted into the bowel per day. This is compounded by reduced oral intake and vomiting. There is loss of intravascular volume and electrolyte depletion. This progress to hypovolemic shock. In mechanical obstruction there is increased peristaltic activity initially in and attempt to overcome blockage.

18. MANAGEMENT 1 . Initial (Conservative) Management : - NPO (Nothing by mouth ) to rest the bowel -IV fluids to correct dehydration and electrolyte imbalance - Nasogastric (NG) tube insertion for decompression (relieves vomiting and distention) - Pain management (carefully, to avoid masking symptoms) - Monitor vitals, abdominal girth, and bowel sounds 2 . Investigations : - Abdominal X-ray / CT scan to confirm obstruction - Blood tests for dehydration, infection, and electrolyte imbalance 3 . Medical Management : -Antibiotics if infection or perforation risk is suspected - Electrolyte correction(e.g ., potassium, sodium) 4 . Surgical Management (if needed ): - Indicated if: - No improvement with conservative treatment - Complete obstruction - Suspected strangulation , ischemia, or perforation - Procedure depends on cause (e.g., tumor removal, adhesiolysis , bowel resection) 5 . Post-Operative Care : - Monitor for return of bowel function (passing flatus, bowel sounds) - Gradual reintroduction of diet - Wound care and infection prevention

19. PREVENTION Dietary & lifestyle Manage underlying conditions Medication caution Monitor after surgery Regular check ups

20. NURSING DIAGNOSIS Acute pain related to distension and obstruction as evidenced by patient verbalizing. Dysfunctional gastrointestinal and motility related impaired peristalsis as evidenced by diarrhea. Risk for deficient fluid volume related to vomiting and NPO status imbalanced nutrition related to GI irritation as evidenced by vomiting

21. PUBLIC HEALTH IMPACT Global prevalence: Appendicitis is one of the most common causes of acute abdominal pain requiring surgery worldwide.  Burden on healthcare systems: High morbidity if untreated Economic impact: Costs of emergency surgery, hospitalization, and loss of productivity.  Public health focus: Early diagnosis and access to surgical care reduce mortality and complications.